Abstract
BackgroundPostoperative acute kidney injury (AKI) is associated with poor clinical outcomes. Early identification of high-risk patients of developing postoperative AKI can optimize perioperative renal management and facilitate patient survival. The present study aims to develop and validate a nomogram to predict postoperative AKI after liver resection in older patients.MethodsA retrospective observational study was conducted involving data from 843 older patients scheduled for liver resection at a single tertiary high caseload general hospital between 2012 and 2019. The data were randomly divided into training (70%, n = 599) and validation (30%, n = 244) datasets. The training cohort was used to construct a predictive nomogram for postoperative AKI with the logistic regression model which was confirmed by a validation cohort. The model was evaluated by receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis in the validation cohort. A summary risk score was also constructed for identifying postoperative AKI patients.ResultsPostoperative AKI occurred in 155 (18.4%) patients and was highly associated with in-hospital mortality (5.2% vs. 0.7%, P < 0.001). The six predictors selected and assembled into the nomogram included age, preexisting chronic kidney disease (CKD), non-steroidal anti-inflammatory drugs (NSAIDs) usage, intraoperative hepatic inflow occlusion, blood loss, and transfusion. The predictive nomogram performed well in terms of discrimination with area under ROC curve (AUC) in training (0.73, 95% confidence interval (CI): 0.68–0.78) and validation (0.71, 95% CI: 0.63–0.80) datasets. The nomogram was well-calibrated with the Hosmer-Lemeshow chi-square value of 9.68 (P = 0.47). Decision curve analysis demonstrated a significant clinical benefit. The summary risk score calculated as the sum of points from the six variables (one point for each variable) performed as well as the nomogram in identifying the risk of AKI (AUC 0.71, 95% CI: 0.66–0.76).ConclusionThis nomogram and summary risk score accurately predicted postoperative AKI using six clinically accessible variables, with potential application in facilitating the optimized perioperative renal management in older patients undergoing liver resection.Trial registrationNCT04922866, retrospectively registered on clinicaltrials.gov on June 11, 2021.
Highlights
Postoperative acute kidney injury (AKI) is associated with poor clinical outcomes
After the exclusion of 77 patients who undertook combined or multiple surgeries, 853 patients were selected with liver resection
Patients were divided into training (599 patients total, 111 postoperative AKI) and validation (244 patients total, 44 postoperative AKI) cohorts, respectively
Summary
Postoperative acute kidney injury (AKI) is associated with poor clinical outcomes. Early identification of high-risk patients of developing postoperative AKI can optimize perioperative renal management and facilitate patient survival. The incidence of postoperative AKI is significantly higher as the filtration capacity of the kidney decreases about 1% every year after the age of 40, even in the healthy population [11, 12]. Aging reduces renal autoregulatory capacity due to physiological and functional changes, leading to different types of kidney diseases, such as vascular sclerosis [13], declining glomerular filtration rate (GFR) [14], thereby enhancing the susceptibility of the older population to postoperative AKI. In contrast to cardiac or vascular surgery-associated postoperative AKI incidence, there are not enough studies on hepatic resection-related AKI onset and its risk factors and prognosis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
